Nasopharyngeal vs. adenoid cultures in children undergoing adenoidectomy: prevalence of bacterial pathogens, their interactions and risk factors.

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus colonization of the adenoids and nasopharynx in 103 preschool children who underwent adenoidectomy for recurrent upper respiratory tract infections was examined. Bacterial interactions and risk factors for bacterial colonization of the nasopharynx and adenoids, separately, were analysed statistically. The prevalence of simultaneous isolation from both anatomical sites was 45·6% for S. pneumoniae, 29·1% for H. influenzae, 15·5% for M. catarrhalis and 18·4% for S. aureus. Three pathogens were significantly more frequent together from adenoid samples; nasopharyngeal swabs more often yielded a single organism, but without statistical significance. M. catarrhalis and S. aureus significantly more frequently co-existed with S. pneumoniae and H. influenzae than with each other and a positive association of S. pneumoniae and H. influenzae in adenoid samples was evident. Several differences between risk factors for nasopharyngeal and adenoid colonization by the individual pathogens were observed. We conclude that the adenoids and nasopharynx appear to differ substantially in colonization by pathogenic microbes but occurrence of H. influenzae and S. pneumoniae in the nasopharynx could be predictive of upper respiratory tract infections.

The segregation and expression of glutamate receptor subunits in cultured hippocampal neurons.

The distribution and expression of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate-selective glutamate receptor subunits (GluR1-4) were studied in cultured hippocampal neurons using antibodies generated against peptides corresponding to the C-termini of GluR1, GluR2/3 and GluR4, and with a set of oligonucleotide probes designed complementary to specific pan, flip and flop GluR1-4 messenger RNA sequences. GluR1-4 subunit proteins were localized in fixed hippocampal neurons (2 h to three weeks after plating) by immunocytochemistry with light and electron microscopy. At early stages in culture, moderate staining with antibodies to GluR1 and GluR2/3 and very light staining with antibody to GluR4 was observed in cell bodies and proximal portions of all neurites of some neurons. Upon establishment of identified axons and dendrites by seven days in culture, staining was intense with specific antibodies to GluR1 and GluR2/3 and light with anti-GluR4 antibody in cell bodies and dendrites. Little or no staining was observed in axons. Cells at seven days in culture exhibited a variety of morphologies. However, we could not assign a pattern of staining to a particular type. As the cultures matured over two and three weeks, staining was limited to the somatodendritic compartment. The intensity of glutamate receptor subunit staining increased and the extent of staining proceeded to the distal extreme of many dendrites. Moreover, antibodies to GluR1-4 subunits were co-localized in neurons. Immunocytochemistry on living neurons did not result in any significant labeling, suggesting that the epitope is either not expressed on the surface of the neurons, or is present, but inaccessible to the antibody. Electron microscopy demonstrated receptor localization similar to that found in brain, with staining of postsynaptic membrane and density, dendritic cytoplasm and cell body, but not within the synaptic cleft. We examined the possible role of "cellular compartmentation" in the pattern of glutamate receptor expression in hippocampal neurons. Compartmentalization studies of the subcellular distribution of messenger RNAs encoding GluR1-4 subunits was determined in mature cultures by in situ hybridization. Significant silver grain appearance was restricted to the cell body, indicating that the synthesis of glutamate receptor subunits is limited largely to the neuronal cell body. The expression of microtubule-associated protein 2 was studied in parallel. Microtubule-associated protein 2 expression appeared 6 h after plating, while glutamate receptor subunit expression was present at 2 h. This indicates that microtubule-associated protein 2 does not regulate the initial distribution of glutamate receptor subunits into neurites.(ABSTRACT TRUNCATED AT 400 WORDS)

The metabotropic glutamate receptors, mGluR2 and mGluR3, show unique postsynaptic, presynaptic and glial localizations.

Glutamate neurotransmission involves numerous ionotropic and metabotropic glutamate receptor types in postsynaptic, presynaptic and glial locations. Distribution of the metabotropic glutamate receptors mGluR2 and mGluR3 was studied with an affinity-purified, characterized polyclonal antibody made from a C-terminus peptide. This antibody, mGluR2/3, recognized both mGluR2 and mGluR3, but did not cross-react with any other type of metabotropic glutamate receptor except for a very slight recognition of mGluR5. Light microscope distribution of the antibody binding sites in the nervous system matched the combined distributions of messenger RNA for mGluR2 and mGluR3. For example, dense staining seen in the accessory olfactory bulb and cerebellar Golgi cells matched high levels of mGluR2 messenger RNA in these structures, while moderately dense staining in the reticular nucleus of the thalamus and light to moderate staining in glia throughout the brain matched significant levels of mGluR3 messenger RNA in these structures. In the rostral olfactory structures, the densest stained neurons belonged to presumptive "necklace olfactory glomeruli." In the hippocampus, staining was densest in the neuropil of the stratum lucidum/pyramidale, stratum lacunosum/moleculare, hilus and middle third of the molecular layer of the dentate gyrus. Ultrastructural studies of the cerebral cortex, hippocampus and caudate-putamen revealed significant staining in postsynaptic and presynaptic structures and glial wrappings of presumptive excitatory synapses; frequently, this staining was concentrated in discrete patches at or near active zones. In the hippocampus, presynaptic staining appeared to be concentrated in terminals of two populations of presumptive glutamatergic axons: mossy fibers originating from granule cells and perforant path fibers originating from the entorhinal cortex. These data suggest that populations of mGluR2 and/or mGluR3 receptors are localized differentially in synapses, i.e. those in and near the postsynaptic and presynaptic membranes and in glial wrappings of synapses, in several regions of the brain. In addition, we provide immunocytochemical evidence of mGluR2 or mGluR3 receptors in presynaptic terminals of glutamatergic synapses. Thus, mGluR2 and mGluR3 are found in various combinations of presynaptic, postsynaptic and glial localizations that may reflect differential modulation of excitatory amino acid transmission.

P2 purinoceptors stimulate inositol phosphate release in the organ of Corti.

We examined the effects of purinoceptor agonists on inositol phosphate (IP) release in the guinea-pig organ of Corti. The P2y receptor agonist ATP-gamma-S (200 microM) increased IPs 4-fold; identical concentrations of alpha, beta-methylene ATP, a P2x agonist, and adenosine, a P1 agonist, did not significantly affect IP release. In calcium-free incubations, simulated IP release decreased by 35% indicating partial dependence of ATP-mediated phosphoinositide hydrolysis on calcium influx. ATP-stimulated IP release was not enhanced by the cholinergic agonist carbachol known to increase IPs via muscarinic receptors in the organ of Corti. This is consistent with the notion that ATP and carbachol have a common target, most likely outer hair cells. P2 purinoceptors coupled to the phosphoinositide cascade suggest ATP as an afferent neuromodulator or efferent neurotransmitter in the cochlea.

Phospholipid metabolism in the cochlea: differences between base and apex.

Phospholipid-derived second messenger systems are one of the primary means for the transduction of extracellular signals to intracellular effector sites. We have investigated the longitudinal distribution of phospholipid metabolism in the guinea pig cochlea because of increasing evidence that the apex and base process auditory signals differently. Phospholipid metabolism was assayed by measuring the incorporation of radioactive phosphate (32Pi) into lipids of the organ of Corti and the lateral wall tissues (stria vascularis and spiral ligament). 32P-labeling of total phospholipids was higher in the apex than the base, and individual phospholipids exhibited a tissue-specific base/apex distribution. Phosphatidylinositol was the most abundant of the labeled lipids in all tissues except the basal lateral wall, where phosphatidylinositol and phosphatidylcholine were labeled to a similar extent. Experiments on the availability of [32P]-ATP and other non-lipid substrates (inositol, choline, and cytidine) suggested that the base/apex distribution of phospholipid metabolism is based on differences in enzymatic activities. Additional evidence for this is an increased hydrolysis of phosphoinositides in the apex. The base/apex distribution of lipid metabolism suggests that physiological and pathological mechanisms involving phospholipids differ between the turns of the cochlea.

Cholinergic regulation of the phosphoinositide second messenger system in the guinea pig organ of Corti.

The effect of cholinergic agents on the phosphoinositide second messenger system was investigated in the cochlea of the adult guinea pig in vivo and in vitro. In vivo, phospholipids were labeled with [32P]-orthophosphate by perilymphatic perfusion and their hydrolysis assayed in 'chase' experiments with non-radioactive orthophosphate. Carbachol (1 mM) reduced the content of 32P-labeled phosphatidylinositol 4,5-bisphosphate in the organ of Corti from 31% to 21% of total 32P-lipids, indicating stimulated hydrolysis. The pharmacology of this effect was studied in detail in vitro via the release of inositol phosphates from phosphoinositides pre-labeled with 3H-inositol. Release was increased 2-fold by 1 mM carbachol, 1.6-fold by 1 mM muscarine, but was unaffected by dimethylphenylpiperazinium; the stimulation was blocked by 1 microM atropine but not mecamylamine. These responses indicate the coupling of phosphoinositides to a muscarinic receptor. Furthermore, stimulated inositol phosphate release was higher in the base of the organ of Corti than in the apex which correlates with the increased cholinergic efferent innervation of outer hair cells in the basal region. These results suggest that muscarinic-stimulated inositol phosphate release occurs at the level of the outer hair cell and thus may have an important modulatory role in auditory transduction.

Expression of the nicotinic acetylcholine receptor subunit, alpha9, in the guinea pig cochlea.

Acetylcholine is a major neurotransmitter of the cochlear efferent system. Based on its high level of expression in hair cells, the recently cloned nicotinic receptor subunit, alpha9 [Elgoyhen et al., Cell 79 (1994) 705-715], is likely to be the postsynaptic receptor for acetylcholine in hair cells either as a homomeric complex or with other subunits yet to be identified. To further study this receptor, we cloned and sequenced alpha9 cDNA from the guinea pig organ of Corti library [Wilcox and Fex, Hear. Res. 62 (1992) 124-126]. The sequence of the guinea pig alpha9 cDNA is similar to that of the rat, with identities of 85% and 89% at the nucleotide and amino acid levels, respectively. Most differences are in the cytoplasmic loop domain between the transmembrane segments 3 and 4. We also observed minor differences in the putative ligand binding regions. Pharmacological differences between acetylcholine receptors on outer hair cells of rat and guinea pig have been reported, and the minor structural changes we observe could account for these differences. Reverse transcription-polymerase chain reaction analysis showed a high expression of alpha9 in the organ of Corti while expression was low or not detected in the spiral ganglion. In situ hybridization histochemistry showed expression of alpha9 mRNA in both inner and outer hair cells, with much higher expression in outer hair cells than in inner hair cells. In the inner hair cell, silver grains were more abundant over the basal part of the cell than over the apical part. Immunocytochemistry showed a pattern of distribution of the alpha9 protein similar to that seen for mRNA with in situ hybridization. Immunolabeling was most intense at the bases of both inner and outer hair cells. To determine the effect of hair cell loss on alpha9 expression, hair cells were destroyed by either systemic or local application of kanamycin. This treatment led to a down regulation of alpha9 in hair cells; this down regulation appeared to precede hair cell degeneration. In the spiral ganglion, a transient up regulation of alpha9, as determined by RT-PCR, was seen 4-6 weeks after kanamycin treatment.

Identification of a glutamate/aspartate transporter in the rat cochlea.

The neurotransmitter at the synapses between hair cells and spiral ganglion cells in the cochlea is probably L-glutamate or a similar excitatory amino acid. Glutamate uptake by nerve terminals and glial cells is an important component of neurotransmission at glutamatergic synapses of the central nervous system, for providing a reservoir of transmitter or transmitter precursors and the termination of the released glutamate. Hair cell synapses are not surrounded by glial cells, therefore, the uptake mechanism for glutamate in the cochlea may be unique. cDNA was synthesized from total RNA isolated separately from the rat organ of Corti, spiral ganglia, and lateral wall tissues. The expression of a glutamate/aspartate transporter (GLAST) was detected by DNA amplification with the polymerase chain reaction. The other two members of glutamate transporters in this family were not detected by this method. A partial cDNA encoding to GLAST was identified by sequence analysis in a rat cochlear cDNA library. Data concerning the expression and the molecular structure of the glutamate transporter GLAST in the cochlea may provide important information regarding the neurotransmission process at the hair cell-afferent synapses.

Acoustic analysis of voice in children with noduli vocales.

The acoustic tests of voice were carried out on 46 children with noduli vocales before the treatment and after its completion. Acoustic parameters of voice were compared with the control group of children without voice pathology. The results of the investigation were analysed acoustically. It has been proved that jitter, shimmer, Fo tremor and HNR values significantly differentiate the children with noduli vocales from the children without pathological changes in the larynx. These parameters during treatment tend to approach normal values. Therefore, the acoustic analysis of voice may be used in treatment monitoring.

[Ovarian mucinous carcinoma in a 12-year old girl]. / Gruczolakorak sluzowy jajnika u 12-letniej dziewczynki.

Epithelial tumors are uncommon in young girls. The case of 12 years old girl (pre-menarche) with ovarian mucinous carcinoma was described. It was successfully treated by completely removed and then was carried out chemotherapy with ADM, CPM and CDDP. Neoplastic markers and laparoscopy was used to follow-up.

[Diagnostic value of directed anamnesis and gynecologic examination with regard to HSG investigation in diagnosis of mechanical infertility in women]. / Wartosc diagnostyczna ukierunkowanego wywiadu i badania ginekologicznego w odniesieniu do badania HSG w rozpoznawaniu mechanicznej nieplodnosci u kobiet.

The aim of the work has been hysterosalpingographic estimation of oviductal patency in women with case histories encumbered or not encumbered by inflammations restricting the fertility, with taking into consideration the anatomical state of the reproductive organs being evaluated by gynaecological examination. Of 429 women covered by the study 102 out of a group of 277 with primary infertility reported adnexitis in their case histories, while 67 women out of a group of 152 with secondary infertility declared having had inflammations. In women, whose anamnesis included inflammations, uterine adnexa thickening as well as abdominal position of uterus with restricted movements appeared in the group of examined women with primary infertility (15.2%) about twofold, and in the group with secondary infertility (26.5%) over fourfold more frequently than in women with inflammatory--free case histories. The women, in whom the gynaecological examinations failed to reveal any changes in genital organs, regardless of the fact that they reported adnexitis, were found to have uni- or bilateral in patency of oviducts from 43.7% to 96.2%, mean in 53.74%, and in those with pubescent uteri on the average 53.75%, with thickened uterine adnexa--mean 64.46% with abdominal position and restricted movements of uterus on the average 74%. Oviductal in patency was recorded twofold more frequently in women, whose case histories disclosed uterine adnexitis.

[Laparoscopy in the diagnosis of chronic painful disorders of the pelvis]. / Laparoskopia w diagnostyce przewleklych dolegliwosci bólowych w miednicy.

The objective of the paper was the evaluation of the results in laparoscopic examinations performed in women reporting chronic painful ailments in the pelvis. The investigation has covered 194 women in whom the laparoscopic procedure was performed by multidirectional diagnostic examinations, and the inflammatory changes had been excluded. The most frequent change recorded during laparoscopy was adhesions of the pelvic organs 103 (53.09%). In 58.63% of cases the cause of adhesions were post inflammatory states of uterine adnexa, in 24.8% the post operative procedures, in 9.2% the adhesions accompanied endometriosis, while in 7.22% the adhesions were the cause responsible for the retroflexion of uterus. In 29.38% the studied group of women was found to have a normal image of the pelvis, and in 8.76% there was a picture of congested pelvis. Laparoscopy is a valuable diagnostic examination, frequently allowing to establish the cause of chronic painful ailments in the area of pelvis, therein also some forms of functional disturbances.

[Nineteen years of laparoscopy in the gynecology clinic IPG PAM]. / Dziewietnascie lat laparoskopii w klinice ginekologii IPG PAM.

The aim of the paper was the analysis of 1450 laparoscopic procedures performed in the Clinic of Gynecology--IOG PMA in Szczecin in the years from 1974 to 1992. The above number include 320 laparoscopic operations. In the analyzed three five-year periods, the number of laparoscopies increased twofold, while in the years 1989-1992 it constituted 26.8% of all the operative procedures. Indication for laparoscopy in 74.6% of cases was sterility, in 13.38% pelvic pain of undefined etiology, in 7.7% ectopic pregnancy, 1.8% oncologic indications, in 0.5% internal ones, in 0.3% sterilization and others in 1.6%. Among operative laparoscopies electrocoagulation of endometriosis was carried out in 46.6% of cases, resection of intraperitoneal adhesions in 27.5%, in the region of abdominal orifices of oviducts in 7.5%, ectopic pregnancy operations in 7.2%, excision of ovarian cysts in 6.6% as well as extirpation of myomas in 4.7%. At the analyzed period the following complications were disclosed, namely: interstitial lesion in 2 cases, hemorrhage from inferior epigastric artery in 1 and subcutaneous emphysema in 34 cases.

[Results of treating endometriosis with infertility using operative laparoscopy]. / Wyniki leczenia endometriozy wspólistniejacej z nieplodnoscia przy zastosowaniu laparoskopii operacyjnej.

In the work, the efficiency of treating endometriosis by hormonal as well as combined methods, and employing the operative laparoscopy was evaluated. The study involved 89 infertile women with endometriosis being of various grade of advancement. Sixty women underwent combined treatment according to Samm, the remaining 29 were given hormonal therapy with Danazol and Orgametril preparations. After combined treatment full recovery was obtained in 26.7% of cases, improvement in 40%, but after the use of preparations Orgametril, Organon or Danazol, Winthrop, complete cure was reached in 12.8% of cases, improvement in 31%. Only 8 women became pregnant after combined therapy. Complete recovery concerned mainly less advanced endometriosis, particularly following the combined treatment according to Semm. Early laparoscopic diagnosis increases the chance of curing endometriosis and fertility associated with it.

[Widely available cytological examinations and detectability of cervical dysplasia and carcinoma]. / Szeroko dostepne badania cytologiczne a wykrywalnosc dysplazji i raka szyjki macicy.

The system of cervical carcinoma prophylaxis introduced in 1974 in the Province of Szczecin based on obligatory obtaining of cytological smears at least one in a year from each woman coming for gynaecological examination and obligatory presentation of the result of this examination by each woman going for sanatorium treatment was analysed. In the years 1974-1986 the number of cytological examinations was systematically increasing, reached recently over 100 thousand, and covered about 30% of the female population aged over 19 years. With increasing number of cytological examinations there was a rise in the detectability of dysplasia and a tendency was noted also recently for reduced incidence of cervical carcinoma. The indices of morbidity and mortality were unchanged.

[Results of microsurgical treatment of non-patency involving the isthmo-intraparietal parts of oviducts in infertile women]. / Wyniki mikrochirurgicznego leczenia niedroznosci czesci ciesniowo-sródsciennej jajowodów u nieplodnych kobiet.

In years of 1984-1992 isthmic and cornual anastomosis oviducts due to their non-patency were performed in 138 woman at the Clinic of Gynaecology--OGI-PMA in Szczecin. Of the mentioned numbered of women the study covered 45 patients having been operating on, during the period from 1.07.1984 to 31.12.1992 and those full data could be collected only for the time-span of one year that followed the operation. In 41 of them cornual and in 4 isthmic anastomoses were accomplished. The operative procedures were carried out by means of magnifying glass and operative microscope. Following the excision of the non-patent part of oviduct, a splinting fibre was introduced into its lumen, whereupon end-to-end anastomosis was formed by employing PDS 7/0-8/0 sutures. Peritoneum at the site of oviductal anastomosis was stitched together with PDS 6/0 sutures. The splinting fibre remained in place till 4-6 days, after the operation. Apart from anastomosis reconstructive operations on abdominal openings of oviducts were also performed in 15 cases, and intraperitoneal adhesions of various intensity degrees were removed in 41 patients. Dextran 70, prometazine and dexamethasone were used in prophylaxis of postoperative adhesions. In 75% cases HSG examination revealed the patency of oviduct in proximal segment, while in the distal segment only in 11 patients operated on. During the period of one year after the operative procedure 14 woman became pregnant.

[The management of cervical cancer cases in pregnancy and puerperium]. / Postepowanie w przypadkach raka szyjki macicy w czasie ciazy i pologu.

UNLABELLED: Cervical cancer in women during pregnancy and puerperium is a serious diagnostic and therapeutic problem. Twelve multiparas with confirmed cervical cancer during pregnancy, delivery and puerperium were examined. The mean age of the group was 35. In two of them cervical cancer was diagnosed in the second trimester, in 5 in the third trimester and in 5 in puerperium. Clinical stage according to FIGO was as follow: Ib--9 patients, IIa--2 patients, III--1 patient. In two patients operated in the second trimester--extended hysterectomy was performed. In four women cesarean section with extended hysterectomy and lymphadenectomy was performed. Only one patient in third trimester had cesarean section and in the same time unradical hysterectomy because of bleeding. In two patients in puerperium extended hysterectomy was performed (Meigs operation). Three patients underwent only radiotherapy. All patients who were operated on underwent subsequent radiotherapy. CONCLUSIONS: Cervical cancer during pregnancy and puerperium is diagnosed very late, usually in advanced stage. It is connected with lack of clinical and cytological examination of women before pregnancy. Principles of treatment of cervical cancer in pregnancy and puerperium do not differ from those applicable in other patients.

[The personality of children with repeated nose injuries]. / Cechy osobowosci u dzieci z powtarzajacymi sie urazami nosa.

Clinical observations of children hospitalised due to head injuries made us try to define some features of personality characteristic for this group of children. The examinations of 63 children aged 8-12 were carried out with R.B. Porter and R.B. Cattell test: What do you like doing? and What do you like to think about?. This method facilitates selection of 14 personality traits. The results proved that personalities tested in the group included the following dominating characteristics: aggressiveness, great excitability, and IQ exceeding average.